‘Unacceptable’ lack of progress on Wales transgender service ‘putting patients at risk’

GPs in Wales are becoming increasingly frustrated with the ‘unacceptable’ lack of progress on a promised transgender enhanced service, which was supposed to be in place by the end of next month.

One LMC warned GPs were concerned the delay was damaging patients mental health and there was a risk they would try and source treatments themselves.

Plans for a specialist clinic in Cardiff supported by a network of GPs with a special interest in gender care and able to provide hormone replacement therapy were announced by the Welsh Government in August 2017.

GPs had been fighting for a service to replace the current system where patients have to travel to London and often have difficulty maintaining treatments without local specialist input.

It was also hoped the service would shorten lengthy waits for treatment.

The proposed enhanced service would be first in the UK – with GPs working to deliver care supported by the gender identity clinic.

GPC Wales chair Dr Charlotte Jones said considerable time and effort had gone into developing the plans and sourcing a network of interested GPs ‘in good faith’ only for their work to be undermined by the other side.

‘Despite continuing pressure from GPC Wales, there has been no progress and, worse, a lack of transparency and seeming ongoing obfuscation as to whether there is a true appetite for delivering the enhanced service,’ she said.

The BMA confirmed to Pulse that while meetings are ongoing nothing has changed despite initial promises the service would be in place by the end of March.

Dr Jones said they had ‘lost confidence’ that a proper service will be put in place, with the Government now trying to impose an inferior service that is not in line with what was agreed.

‘We have continued to engage and discuss and educate those involved in putting forward business cases for the service and have done this in good faith.

‘However, the other side have continued to undertake actions that not only undermine the process with a lack of transparency over many key areas involved in developing the service and seeming obfuscation as to whether there is a true appetite for delivering the enhanced service.’

She added: ‘The entire process has been unsatisfactory, unacceptable and GPC Wales now feels the time for engagement in good faith is over.

‘GPC Wales, the GP profession and the transgender community deserve better than this and will not accept less than this.’

The LMC wrote to the NHS Wales chief executive to express their concerns that the setting up of the service was taking too long.

‘It now appears that talks have stalled. Our GPs feel very strongly about the risks this poses to their patients. There is lots of concern about patients sourcing medication themselves or the mental health effects of not being able to access treatment.’

A Welsh Government spokesman said: ‘We are committed to delivering improved healthcare services for the transgender community in Wales.

‘We expect all those involved in delivering this new service to work together to ensure it is a success.’

Readers' comments (4)

GPs need to concentrate on common conditions and uncommon but important if missed conditions (i.e. don't miss PE, cauda equina etc).Managing medications for transgender patients is still uncommon(as in numbers of patients / practice) and non urgent so it is the lowest priority for GPs to up skill on. Leaving these patients for many GPs to manage WILL lead to drug and monitoring errors due to the low numbers of patients / GP.

Whilst fully supporting the right of any adult to legally define their own gender (and condemning any social discrimination and appalling bullying they suffer), the question remains as to whether the NHS should foot the transgender treatment bill during a period of extraordinary financial hardship. Suicidal children are rejected by CAMHS, hip replacements are classed as “low clinical priority”, and A&E is in perma-crisis. There is also widespread concern about the safety of injecting massive doses of testosterone/oestrogen into otherwise healthy young adults. And as B&S states above, there certainly isn’t the necessary expertise here in primary care.